American Republican anti-healthcare reformers take note: you’re not going to like this post. If the thought of government-provided medicine fills your heart with apprehension, read on and let me know how you feel by the end of my story.
I’ve spent the day in the Royal Brompton, a guest of the NHS, specifically under the care of one Professor Michael Gatzoulis, who literally wrote the book – in this case, Grey’s Anatomy – on matters arising from the thorax, and I am delighted that as my thorax is less than one would want it, he is nominally in charge.
It all started a few months back when I felt my heart flopping around in my chest like a newly landed fish for a few startling minutes. I sent Michael an email outlining my symptoms, and shortly afterwards, got an email back offering an out patient’s appointment. Most of this is written in the waiting areas between the various stations of the examination.
Kick off is at 9am, with an echocardiogram. I have a technician with either a terrible bedside manner or an appalling hangover. I am rolled around until I am resting my weight uncomfortably on the contents of my pocket, and assume a pose much like a horizontal nude from the 1940s while the technician sits in the small of my back, slicks a probe with goop and presses it firmly into my ribs.
The monitor is behind my head, so I don’t get to see the workings of my insides, but at one point the volume is turned up, and I can hear the liquid swooshing through this valve and thrumming through that. It makes me think that my chest needs a roadie inside it, listening out to suggest that mic two sounds a bit ‘toppy’.
I have a lot to thank this machine for; in 1984, it was still a relatively new bit of kit, and the National Heart Hospital had one of the first at the end of the ward I lived on. The pictures – of the inside of a heart, working in real time and in high enough definition to be useful to someone who knew what they were looking at – were recorded on VHS tape. Years later, when I found a lump on a testicle, I spent twenty minutes in the delightful company of a lady from Florida who slathered my nether regions in (apparently refrigerated) gel and poked about until I got the all-clear.
Yes, it’s a messy business, and by the end of this exam, I have a blob of goo on my chin which I wipe off with a scrunch of the butcher paper I’ve been lying on.
Next up is the ECG, which has changed significantly since the first time I had it done. Again, this once required the smearing of goo on one’s chest, and suckers that left round, red marks, and leg and wrist cuffs. Now it’s all done with strategically-placed stickers that tug the hairs out of your skin but are otherwise a lot cleaner.
Also, there was a time when the results would chug from a spool of paper, the lines drawn by biros as a nurse told you to lie still; now it slides smoothly through a laser jet, the test completed almost before you know they have started.
The major change with all of these tests is the speed at which they happen. Diagnosis is occasionally a mildly humiliating and/or cold experience for the patient, and in thirty years, no one has thought to warm up the plate against which one presses in order to have a chest X-ray, but whereas I used to have to wait while it was developed, it is now on a screen as I am buttoning up my shirt for the fourth time today.
I am seen by Lesley Jones, one of the team of doctors at the Royal Brompton. She reminds me slightly of comedy industry legend Hils Jago with a twinkling demeanour and attitude that invites questions, but not necessarily argument.
She is slightly alarmed by the extent of my weight loss until I tell her it was intentional, though I am conscious that the suit I’ve already had taken in once is now hanging off me, and I’ve got a client meeting this afternoon. Blood pressure is normal – and Lesley says ‘normal’ without adding the qualifier ‘for you.’ We talk health and fitness, and Lesley is encouraging about my swimming and runs around the mountain. I wouldn’t call my exercise regime hard work, but I would admit that it takes some effort to make it part of my lifestyle. In other words, watch your habits; they become your diagnosis.
At the end, possibly as a punishment for being so boringly normal, Lesley packs me off to have my blood done. Now you’re just looking for trouble, I think, steeling myself for the last test of the day, which will include the functioning of thyroid and liver. I think of the number of times I’ve seen the underside of a table this year and say goodbye.
Donna is cheerful, sparkly, and honest: ‘This is going to hurt,’ she promises as she jabs a needle into my forearm, and takes enough blood out of me to test for every disease known to medical science and still have enough left over to make a black pudding.
‘One woman said it was like a hot nail,’ Donna continues, as she fills vials with blood and seals them up in bags with alarming biohazard hieroglyphics. I contemplate the gaudy tourniquet, and think how this job must skew a person’s notions of ‘squeamish’. By necessity, I’ve got used to people sticking needles in me, and I have to report, Donna does a better job than most; my last blood test had me coming up with bruises like an inept junkie.
And so I go out into the day, my suit flapping about me, a clean bill of health (blood results pending) behind and a client meeting in front – with the delightful Nick Foulkes, who takes my bizarre appearance in his (considerably better-tailored) stride.
Look, the NHS is not perfect, but it works. I cannot imagine I would have had this number of tests if I’d had to pay up front: what would it cost, £1,000? £2,000? Probably more if there were the trappings of private medicine, fresh flowers and the latest GQ in the waiting room and Lesley got what she is worth.
I’ve been to a private clinic, and didn’t get the same level of care, or even privacy: I had my blood pressure taken while an unfortunate gentleman had his circumference measured mere feet away. When I found out what it cost – and that they were prepared to do a further expensive and useless cholesterol test (I’d eaten, which skews the results; they were prepared to take the cash and carry on regardless) – I clutched my chest in dramatic fashion, made my excuses, and left.
And don’t get me started on alternative medicine. Even the surly echo technician did me more good than a hundred homeopaths. You might not like mardy staff, but I do: imagine if the person before you had had a heart attack, and had been wheeled out to an unknown fate. Do you want the person who’s going to process you in a perfectly adequate and disinterested manner, just as they have done to everyone else? Or do you want the empathic, distracted person who’s worried about the unfortunate fellow having his chest pumped up the corridor?
This isn’t to say alternative medicine is useless, far from it. Alternative medicine tells us a lot about how the human brain works: it is the perception of a candlestick when you are in fact looking at two profiles. Lesley took me through my numbers, and I trust a shadow on an X-ray, or a squiggle on an ECG that will hint at trouble long before your aura turns a funny colour. Alternative medicine is a belief system; science is a doubt system. What does a homeopath know (or care) about a synapse, the electrical pathways across a heart, oxygen? If alternative medicine worked where conventional medicine didn’t, legitimate doctors would be crowding around to admire the results. This has, in fact already happened: it’s called the placebo effect, and is built into every legitimate clinical trial. It won’t surprise you to learn that the placebo effect is rigorously excised from tests that find in favour of homeopathy.
The placebo effect, by the way, isn’t always beneficial; there are a number of studies on the effect of prayer on clinical outcomes. As expected, when a patient doesn’t know they are being prayed for, it doesn’t make any difference. In one study I’ve read, cardiac patients who do know their situation is so wretched a higher power has to get involved, suffer increased mortality. So if you wish, on reading this, to offer one up on my behalf, please don’t tell me about it.
I know a student doctor, and I briefly entertained the notion that he might find this ‘patient’s-eye’ tour of the process useful. It would, of course, be more interesting to take one of my friends who is keen on alternative medicine – and I have several, for my circle of friends is wide and ecumenical – and see how (or even if) this changes their mind. There is an arrogance about the waggling of pendulums, the feeling of ‘energy’, casting of runes, when we should be feeling humble in the face of science that tells us something about our bodies. Evolution is a couple of billion years of R&D, and it’s remarkable how we’ve unravelled so much so quickly with the technology we have. Disembowel all the chickens you want, they will tell you nothing about the world beyond the strange and creative nature of human misunderstanding.
I am contemplating getting a tattoo that reads: ‘Caution: this unit contains no user-serviceable parts. Please refer to an accredited outlet.’
It might look good in Latin, I suppose.